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Wuyts K, Durston V, Morstyn L, Mills S, White V. Information needs in breast reconstruction after mastectomy: a qualitative analysis of free-text responses from 2077 women. Breast Cancer Res Treat 2024; 205:147-157. [PMID: 38300358 PMCID: PMC11063103 DOI: 10.1007/s10549-023-07240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND For many, breast reconstruction following mastectomy (BR) forms an integral part of breast cancer survivorship. For those considering BR, provision of information is essential to allow informed decisions. Using free-text responses from a survey of breast cancer survivors, this study aims to understand current gaps in information regarding BR. METHOD At the end of an online survey assessing BR experiences, participants were asked the open-ended question: "Thinking about women who may experience BR in the future, is there anything you think needs to change so that they have a better experience?". Responses were analysed to identify common themes. RESULTS 3384 people completed the survey with 2,077 (61%) responding to the open-ended question. Three themes were identified: (1) content of information, (2) managing expectations, and (3) information sources, each associated with multiple subthemes. Information wanted in theme (1) covered a range of topics including BR options, risks, recovery and 'going flat.' Information on BR's psychological impact was also needed, with comments indicating many were not prepared for this. Theme (2) stressed the importance of realistic information about BR outcomes and processes to reduce discrepancies between expectations and experiences. In theme (3), peer insights and photos were important sources of realistic information. CONCLUSION Multiple gaps exist in BR-related information available to women. BR information needs to be comprehensive, realistic, and provided at the right time to allow informed decision-making. Developing strategies to strengthen existing information provision as well as new resources to fill information gaps might enhance BR experiences.
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Affiliation(s)
- Kim Wuyts
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, 3220, Geelong, VIC, Australia
| | - Vicki Durston
- Breast Cancer Network Australia, Camberwell, VIC, Australia
| | - Lisa Morstyn
- Breast Cancer Network Australia, Camberwell, VIC, Australia
| | - Sam Mills
- Breast Cancer Network Australia, Camberwell, VIC, Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, 3220, Geelong, VIC, Australia.
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Shah JK, Amakiri UO, Cevallos P, Yesantharao P, Ayyala H, Sheckter CC, Nazerali R. Updated Trends and Outcomes in Autologous Breast Reconstruction in the United States, 2016-2019. Ann Plast Surg 2024; 92:e1-e13. [PMID: 38320006 DOI: 10.1097/sap.0000000000003764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Autologous breast reconstruction (ABR) has increased in recent decades, although concerns for access remain. As such, our goal is to trend national demographics and operative characteristics of ABR in the United States. METHODS Using the National Inpatient Sample, 2016-2019, the International Classification of Disease , Tenth Edition codes identified adult female encounters undergoing ABR. Demographics and procedure-related characteristics were recorded. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate regression modeling. RESULTS A total of 52,910 weighted encounters met the criteria (mean age, 51.5 ± 10.0 years). Autologous breast reconstruction utilization increased (Δ = +5%), 2016-2019, primarily driven by a rise in deep inferior epigastric perforator (DIEP) reconstructions (Δ = +28%; incidence rate ratio [IRR], 1.070; P < 0.001), which were predominant throughout the study period (69%). More recent surgery year, bilateral reconstruction, higher income levels, commercial insurance, and care in the South US region increased the odds of DIEP-based ABR ( P ≤ 0.036). Transverse rectus abdominis myocutaneous flaps, bilateral reconstructions, higher comorbidity levels, and experiencing complications increased the length of stay ( P ≤ 0.038). Most ABRs (75%) were privately insured. The rates of immediate reconstructions increased over the study period (from 26% to 46%; IRR, 1.223; P < 0.001), as did the rates of bilateral reconstructions (from 54% to 57%; IRR, 1.026; P = 0.030). The rates of ABRs performed at teaching hospitals remained high (90% to 93%; P = 0.242). CONCLUSIONS As of 2019, ABR has become more prevalent, with the DIEP flap constituting the most common modality. With the increasing ABR popularity, efforts should be made to ensure geographic and financial accessibility.
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Affiliation(s)
- Jennifer K Shah
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | | | | | - Pooja Yesantharao
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Haripriya Ayyala
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Clifford C Sheckter
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Rahim Nazerali
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
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3
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Soon PS, Karimi N, Wu VS, Girgis A. Having breast reconstruction post-mastectomy: barriers and facilitators reported by Vietnamese- versus English-speaking women with breast cancer. ETHNICITY & HEALTH 2022; 27:343-360. [PMID: 31746239 DOI: 10.1080/13557858.2019.1693513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
Objective: Little is known about the experience of women of culturally and linguistically diverse (CALD) backgrounds in relation to breast reconstruction following mastectomy as treatment for their breast cancer. The aim of this study was to explore the factors that influenced Vietnamese- and English-speaking women's decisions about breast reconstruction post-mastectomy for their breast cancer, in Australia.Design: The participants in this study comprised of Vietnamese-speaking women of Vietnamese heritage, and English-speaking women from mixed ethnicities (Vietnamese included). In this qualitative study, Vietnamese-speaking and English-speaking women who had breast cancer treated by mastectomy with or without breast reconstruction participated in in-depth interviews. Interviews were undertaken in the woman's chosen language (Vietnamese or English), audio-recorded, transcribed/translated and analysed using thematic analysis.Results: Fourteen Vietnamese-speaking and 13 English-speaking patients were recruited. Participants identified age, lack of information, concerns regarding surgical procedure, fears about complications and cancer recurrence as barriers to breast reconstruction. Many more Vietnamese-speaking participants identified lack of information about breast reconstruction as a barrier compared to English-speaking participants. Both groups described the ability to wear clothing of their choice, partner influence, and the need to feel 'normal' as facilitators to having breast reconstruction. Vietnamese-speaking participants in particular identified doctor recommendation of breast reconstruction as a major facilitator.Conclusion: Lack of information about reconstruction was a persistent theme, though it was identified by more Vietnamese women as a barrier to having breast reconstruction. The results reinforce the importance of doctors' recommendations in helping particularly the Vietnamese women make an informed decision about reconstruction following mastectomy as treatment for their breast cancer.
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Affiliation(s)
- Patsy S Soon
- Department of Surgery, Bankstown Hospital, Bankstown, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Neda Karimi
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Verena S Wu
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Afaf Girgis
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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Kanapathy M, Burentuvshin O, Varghese J, Naderi N, Canny R, Mosahebi A. Priority setting in breast reconstructive surgery: A DELPHI consensus. J Plast Reconstr Aesthet Surg 2021; 75:1297-1315. [PMID: 34955391 DOI: 10.1016/j.bjps.2021.11.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Breast reconstructive surgery is often performed following breast cancer treatment to restore the natural appearance of the breast. Despite various research performed in this field, there is a discrepancy between the research question that is considered crucial jointly by patients, carers and healthcare professionals and the research performed. The Breast Reconstruction Priority Setting Partnership was formed to determine the top research priorities in all aspects of breast reconstructive surgery. METHODS The Priority Setting Partnership (PSP) was conducted in line with James Lind Alliance (JLA) principles involving patients and clinicians. An online survey was conducted to gather uncertainties related to breast reconstruction by involving patients, carers and clinicians. Following this, a modified Delphi consensus process was performed to identify the top 10 research priorities. RESULT A total of 239 unique research uncertainties were identified via the online survey, which involved 100 participants. A review of literature established that 58 of these uncertainties did not have a high-quality systematic review, prompting the need for more in-depth research. A further 28 research uncertainties were obtained by performing a literature search. Of the final 86 unique questions, the Delphi panel achieved consensus on the top ten research priorities. Recommendations to address these research priorities have been put forward based on current evidence. CONCLUSION This study involved patients, carers and healthcare professionals to establish the top 10 priority areas for research in breast reconstructive surgery. Recommendations have been put forward on the necessary future research that is required to address these uncertainties.
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Affiliation(s)
- Muholan Kanapathy
- Division of Surgery & Interventional Science, University College London, UK; Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Orgil Burentuvshin
- Division of Surgery & Interventional Science, University College London, UK.
| | - Jajini Varghese
- Division of Surgery & Interventional Science, University College London, UK; Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Naghmeh Naderi
- Division of Surgery & Interventional Science, University College London, UK; Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Rebecca Canny
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Afshin Mosahebi
- Division of Surgery & Interventional Science, University College London, UK; Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
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Couples' Experience of the Decision-Making Process in Breast Reconstruction After Breast Cancer: A Lexical Analysis of Their Discourse. Cancer Nurs 2021; 43:384-395. [PMID: 31033513 DOI: 10.1097/ncc.0000000000000708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND One in 3 women with breast cancer will have a mastectomy and face the decision of whether to have breast reconstruction (BR). This decision is shared by the women and their physician, as well as discussed with her partner. OBJECTIVE This study aimed to understand the decision-making process of BR through a lexical analysis of the women and their partners' discourse. A secondary aim was to identify the differences between the couples when the woman had, or did not have, BR. METHODS We conducted semistructured interviews with 9 women, and their partners, who underwent a mastectomy after a first episode of breast cancer. A lexical analysis using IRaMuTeQ software was carried out. RESULTS The analysis yielded 3 classes, each one being more represented by one of the different BR categories. Class 1 contained words reflecting a preoccupation with body modification. Class 2 was related to the surgery and its consequences. Words contained in class 3 were about the couples' issues regarding surgeries, treatments, and medical care. The question of temporality emerged particularly in classes 2 and 3. CONCLUSIONS This study underlines the differences in the discourse of couples when talking about BR decision-making. Furthermore, it shows the importance of giving women time to think about BR and discuss its issues. IMPLICATION FOR PRACTICE Decisions about BR are difficult to make and should always be discussed between the women and health professionals, as BR is not always possible or desired by women. Partners need to be included in treatment decision-making.
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Park EY, Yi M, Kim HS, Kim H. A Decision Tree Model for Breast Reconstruction of Women with Breast Cancer: A Mixed Method Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073579. [PMID: 33808263 PMCID: PMC8036358 DOI: 10.3390/ijerph18073579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022]
Abstract
The number of breast reconstructions following mastectomy has increased significantly during the last decades, but women are experiencing a number of conflicts with breast reconstruction decisions. The aim of this study was to develop a decision tree model of breast reconstruction and to examine its predictability. Mixed method design using ethnographic decision tree modeling was used. In the qualitative stage, data were collected using individual and focus group interviews and analyzed to construct a decision tree model. In the quantitative stage, the questionnaire was developed questions based on the criteria identified in the qualitative stage. A total of 61 women with breast cancer participated in 2017. Five major criteria: recovery of body image; impact on recurrence; recommendations from others; financial resources; and confirmation by physicians. The model also included nine predictive pathways. It turns out that the model predicted 90% of decisions concerning whether or not to have breast reconstruction. The findings indicate that the five criteria play a key role in decision-making about whether or not to have breast reconstruction. Thus, more comprehensive issues, including these five criteria, need to be integrated into an intervention for women with breast cancer to make their best decision on breast reconstruction.
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Affiliation(s)
- Eun Young Park
- College of Nursing, Gachon University, Incheon 21936, Korea;
| | - Myungsun Yi
- College of Nursing, Seoul National University, Seoul 03080, Korea;
| | - Hye Sook Kim
- Department of Nursing, Suwon Science College, Suwon 18516, Korea;
| | - Haejin Kim
- Department of Nursing, Suwon Women’s University, Suwon 16632, Korea
- Correspondence:
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Anderson SR, Tuttle RM, Markov LCNP, Johnson RM, Fox LCJP. The surgical treatment of breast cancer: A journey, not a procedure. Breast J 2020; 26:2441-2443. [PMID: 33040436 DOI: 10.1111/tbj.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Spencer R Anderson
- Division of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Rebecca Mae Tuttle
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | | | - R Michael Johnson
- Division of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Lieutenant Colonel Justin P Fox
- Division of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.,Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.,Plastic Surgery Element, Surgical Operations Squadron, Wright Patterson Medical Center, Wright Patterson AFB, OH, USA
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8
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Shiraishi M, Sowa Y, Fujikawa K, Kodama T, Okamoto A, Numajiri T, Taguchi T, Amaya F. Factors associated with chronic pain following breast reconstruction in Japanese women. J Plast Surg Hand Surg 2020; 54:317-322. [PMID: 32589082 DOI: 10.1080/2000656x.2020.1780246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Chronic pain after breast surgery including breast reconstruction is a major concern for patients. However, the factors associated with chronic pain after breast surgery are uncertain in Japanese population. The aim of this study was to identify patient-specific and medical/surgical factors that predict chronic pain after breast surgery in Japanese patients. The subjects were 189 Japanese women undergoing breast surgery including tissue expander/implant (TE/implant), deep inferior epigastric perforator (DIEP) procedures and mastectomy only. Pain was assessed at one year postoperatively using a validated survey instrument: the Japanese version of the Short-Form McGill Pain Questionnaire (SF-MPQ-JV). A multiple linear regression model was used to examine the relationships of clinical factors with postoperative pain. Surveys were completed by 141 subjects. A younger age (p = .04) and bilateral procedures (p < .05) were both closely associated with the extent of increased postoperative pain at 1 year using the MPQ-Total pain rating. Compared to total mastectomy only, TE/implant procedures showed a significantly lower visual analog scale (VAS) (p = .04) and present pain index (PPI) (p = .03) scores. No factor related to chronic pain was also significantly related to the frequency of pain medication use postoperatively or the effect of social life of the patients. This study identified patients at risk for greater chronic pain after breast surgery. These findings will allow surgeons to improve patient comfort, reduce clinical morbidity and enhance patient satisfaction with their surgical outcome. Abbreviations: BMI: body mass index; CI: confidence interval; DIEP: deep inferior epigastric perforator flap; MPQ: McGill pain questionnaire; PPI: present pain index; SD: standard deviation; SF-MPQ-JV: Japanese version of the short-form McGill pain questionnaire; TE: tissue expander; VAS: visual analog scale.
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Affiliation(s)
- Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Fujikawa
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuya Kodama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akiko Okamoto
- Department of Breast Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Toshiaki Numajiri
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuya Taguchi
- Department of Endocrinological and Breast Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumimasa Amaya
- Pain Management and Palliative Care Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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9
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Miseré R, Schop S, Heuts E, de Grzymala AP, van der Hulst R. Psychosocial well-being at time of diagnosis of breast cancer affects the decision whether or not to undergo breast reconstruction. Eur J Surg Oncol 2020; 46:1441-1445. [PMID: 32220543 DOI: 10.1016/j.ejso.2020.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Numerous studies have shown that breast reconstruction after mastectomy improves QoL in breast cancer survivors. However, still about half of the patients does not opt for reconstruction. In order to accommodate suitable counseling, we should elucidate the factors that play a role in the decision-making process. This study aimed to evaluate the influence of QoL, among women diagnosed with breast cancer before the start of any treatment, on their decision whether or not to undergo breast reconstruction. MATERIALS AND METHODS BREAST-Q surveys were provided to breast cancer patients at the specialized breast care outpatient clinic after their first consultation with a surgical oncologist, between June 2017 and March 2019. The Q-scores of the subdomains physical well-being, psychosocial well-being, sexual well-being, and satisfaction with breasts of patients that underwent mastectomy were statistically analyzed. RESULTS Sixty-seven patients, undergoing mastectomy, completed the questionnaire. Fifty-four percent received reconstructive surgery. Mean age of patients seeking breast reconstruction was significantly lower than patients who did not opt for a reconstruction (53.5 vs. 63.7). Mean follow-up after mastectomy was 18.1 months. Except for satisfaction with breasts, mean Q-scores were higher in the group of patients who did not choose for reconstructive surgery. Psychosocial well-being was significantly higher in the non-reconstruction group (p = 0.012). CONCLUSIONS Psychosocial well-being at time of diagnosis of breast cancer was significantly higher in patients refraining from breast reconstructive surgery after mastectomy. Psychosocial characteristics might be essential for the decision-making process as well. Further prospective research should evaluate this.
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Affiliation(s)
- Renée Miseré
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Sander Schop
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Esther Heuts
- Department of General Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - Andrzej Piatkowski de Grzymala
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
| | - René van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands
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Marouf A, Mortada H, Fakiha MG. Psychological, sociodemographic, and clinicopathological predictors of breast cancer patients' decision to undergo breast reconstruction after mastectomy. Saudi Med J 2020; 41:267-274. [PMID: 32114599 PMCID: PMC7841554 DOI: 10.15537/smj.2020.3.24946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/16/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine the influence of socioeconomic factors, anxiety, depression, and personality traits on the decision to undergo breast reconstruction (BR) post mastectomy. METHODS In this cross-sectional study, adult female breast cancer (BC) patients who had undergone a mastectomy between January 2017 and 2019 were interviewed using a 46-item questionnaire at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The questionnaire was divided into 5 sections: demographic data, personality traits, the Narcissism Index (NI), and the Hospital Anxiety and Depression Scale (HADS). Results: The sample (N=196; mean age: 48.44 [± 9.87] years, opted for BR: 60.2%, with chronic diseases: 36.7%, Saudi nationals: 43.9%) obtained means of 4.17 (± 2.81) on NI score, 7.72 (± 4.88) on anxiety score, and 5.78 (± 4.65) on depression score. Group differences in age, depression, lymph node involvement, and 2 personality traits emerged. CONCLUSION Age and depression significantly influenced the decision to undergo BR. Women who had opted for BR tended to be younger, be less depressed, and be characterized by lesser nodal involvement. Personality traits also influenced the decision to undergo BR. Diagnosing and treating depressed patients is an important component. A patient's age should not deter physicians from counselling them about BR.
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Affiliation(s)
- Azmi Marouf
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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11
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Abstract
Postmastectomy reconstruction has been shown to be oncologically safe, but few studies have investigated factors influencing the type of reconstruction chosen, if at all. Records of female patients with stages 0 to 3 breast cancer undergoing mastectomy at a large academic institution between January 2010 and March 2018 were reviewed. Nine hundred sixty patients were included in this cohort; 784 patients had reconstruction. Younger age, earlier disease stage, private insurance, no history of diabetes, and bilateral mastectomy (BM) were associated with reconstruction. On multivariate analysis, younger age, BM, private insurance, and earlier disease stage predicted reconstruction. Of reconstruction patients, 453 had implants. Race, BMI, and later disease stage influenced the type of reconstruction; on multivariate analysis, higher BMI and later disease stage predicted flap reconstruction. Younger age, BM, private insurance, and earlier disease stage were associated with reconstruction, but the type of reconstruction was affected primarily by BMI and disease stage.
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Affiliation(s)
- Julian Huang
- From the Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Melinda Wang
- From the Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Anees Chagpar
- From the Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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12
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Laza-Vásquez C, Rodríguez-Vélez ME, Lasso Conde J, Perdomo-Romero AY, Pastells-Peiró R, Gea-Sánchez M. Experiences of young mastectomised Colombian women: An ethnographic study. ENFERMERIA CLINICA 2019; 31:107-113. [PMID: 31791882 DOI: 10.1016/j.enfcli.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the experiences of a group of young women in relation to the reconstruction of their breasts after mastectomy. METHOD Focused ethnography, performed in the League against Cancer- Huila Section (Colombia). Through casual sampling oriented by criteria, semi-structured interviews were conducted with eight young women (diagnosed at 45 years or earlier) with breast cancer (reconstructed or not reconstructed after mastectomy) until saturation of discourse. Data collection was carried out between August-November 2017, after the endorsement of the Ethics Committee and the consent of the participants. Data was analysed using the thematic analysis technique after being anonymised. RESULTS Three issues emerged in the women's discourses: The social stigma of being a young woman with breast cancer; learning to live with a body transformed by disease and treatment, and surviving, which is the most important thing. CONCLUSIONS Being a young woman, and suffering from breast cancer implies a diversity of changes that permanently alter the lives of women and their bodies. Women prioritise survival in order to take care of others over breast reconstruction. At a healthcare level, the cultural and gender perspective must be incorporated to design individualised nursing interventions that contribute to better care.
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Affiliation(s)
- Celmira Laza-Vásquez
- Grupo de investigación «Salud y Grupos Vulnerables», Programa de Enfermería, Universidad Surcolombiana, Neiva, Departamento del Huila, Colombia.
| | - María Elena Rodríguez-Vélez
- Grupo de investigación «Salud y Grupos Vulnerables», Programa de Enfermería, Universidad Surcolombiana, Neiva, Departamento del Huila, Colombia
| | - Jasleidy Lasso Conde
- Grupo de investigación «Salud y Grupos Vulnerables», Programa de Enfermería, Universidad Surcolombiana, Neiva, Departamento del Huila, Colombia
| | - Alix Yaneth Perdomo-Romero
- Grupo de investigación «Salud y Grupos Vulnerables», Programa de Enfermería, Universidad Surcolombiana, Neiva, Departamento del Huila, Colombia
| | - Roland Pastells-Peiró
- Grupo de Estudios Sociedad, Salud, Educación y Cultura (GESEC), Facultad de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, España; Grup de Recerca en Cures de la Salut (GRECS), Institut de Recerca Biomèdica de Lleida, Lleida, España
| | - Montserrat Gea-Sánchez
- Grupo de Estudios Sociedad, Salud, Educación y Cultura (GESEC), Facultad de Enfermería y Fisioterapia, Universitat de Lleida, Lleida, España; Grup de Recerca en Cures de la Salut (GRECS), Institut de Recerca Biomèdica de Lleida, Lleida, España
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Edward KL, Chipman M, Stephenson J, Robinson K, Giandinoto JA, Trisno R. Recovery in early stage breast cancer-An Australian longitudinal study. Int J Nurs Pract 2019; 25:e12747. [PMID: 31168880 DOI: 10.1111/ijn.12747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 04/16/2019] [Accepted: 04/20/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND The majority of breast cancer patients will experience some level of emotional distress, with some patients having long-term psychological maladjustment. Personal and social resources play a role in recovery yet the interplay between these factors warrants further examination. This study aimed to investigate the interaction of psychosocial factors impacting women in their breast cancer trajectory, at 2 years or less following diagnosis (stages I-III). DESIGN A longitudinal cohort study approach was used in this study. METHODS The sample consisted of n = 49 participants. Data were collected between June 2013 and October 2013 and followed for 12 months across the trajectory of the disease. RESULTS The mean age was 56.6 years (SD 11.6 years). Most participants had stage I or stage II breast cancer. Time (over three time points-4 weeks, 6 months, and 12 months) after diagnosis was significantly associated with the body image (P = .003) and age (P = .004). CONCLUSION Older women with breast cancer reported less concern regarding body image than their younger peers. These findings suggest that posttreatment younger women may require access to psychological support posttreatment.
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Affiliation(s)
- Karen-Leigh Edward
- Nursing and Practice-based Research, Swinburne University of Technology, Melbourne, Australia.,St Vincent's Private Hospital Melbourne, Melbourne, Australia.,School of Human and Health Science, University of Huddersfield, Huddersfield, UK
| | - Mitchell Chipman
- Victorian Breast and Oncology Care, East Melbourne, Victoria, Australia
| | - John Stephenson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Kayte Robinson
- Victorian Breast and Oncology Care, East Melbourne, Victoria, Australia
| | - Jo-Ann Giandinoto
- Australian Catholic University, Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine (Melbourne), Fitzroy, Victoria, Australia
| | - Roth Trisno
- Albury Wodonga Health, Wodonga, Victoria, Australia.,Albury Wodonga Health, Albury, New South Wales, Australia
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Archangelo SDCV, Sabino M, Veiga DF, Garcia EB, Ferreira LM. Sexuality, depression and body image after breast reconstruction. Clinics (Sao Paulo) 2019; 74:e883. [PMID: 31166474 PMCID: PMC6542498 DOI: 10.6061/clinics/2019/e883] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/17/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression. METHODS This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively. RESULTS The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics. CONCLUSION Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group.
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Affiliation(s)
| | - Miguel Sabino
- Programa de Pos-graduacao em Cirurgia Translacional, Departamento de Cirurgia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Daniela Francescato Veiga
- Programa de Pos-graduacao em Cirurgia Translacional, Departamento de Cirurgia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Ciencias Medicas, Universidade do Vale do Sapucai, Pouso Alegre, MG, BR
| | - Elvio Bueno Garcia
- Disciplina de Cirurgia Plastica, Departamento de Cirurgia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Lydia Masako Ferreira
- Disciplina de Cirurgia Plastica, Departamento de Cirurgia, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
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15
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Lee WQ, Tan VKM, Choo HMC, Ong J, Krishnapriya R, Khong S, Tan M, Sim YR, Tan BK, Madhukumar P, Yong WS, Ong KW. Factors influencing patient decision-making between simple mastectomy and surgical alternatives. BJS Open 2018; 3:31-37. [PMID: 30734013 PMCID: PMC6354187 DOI: 10.1002/bjs5.50105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background Despite similar survival rates, breast‐conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early‐stage breast cancer in Singapore. Uptake of reconstruction after mastectomy is also low (18 per cent). The aim of this study was to explore the factors influencing a patient's choice for mastectomy when eligible for BCT, and why patients decline reconstruction after mastectomy. Methods Patients from the National Cancer Centre Singapore, who were eligible for BCT but chose mastectomy without reconstruction, between December 2014 and December 2015 were included. An interviewer‐administered questionnaire focusing on patients' reasons for choosing mastectomy over BCT and not opting for immediate breast reconstruction after mastectomy was used. Tumour characteristics were retrieved from medical records. Spearman's rank correlation coefficient, Mann–Whitney U and Kruskal–Wallis tests were used to analyse the correlation between the patient's self‐rated influential factors and variables. Statistical significance was taken as P < 0·050. Results Ninety‐one patients were included (90·1 per cent response rate). The main reasons for choosing mastectomy over BCT were: fear of cancer recurrence (considered very important in 74 per cent), the perception that health outweighs breast retention (49 per cent) and the possibility of second surgery for margins (40 per cent). Key factors for rejecting immediate reconstruction after mastectomy were: patient‐perceived ‘old age’ (very important in 53 per cent), concern about two sites of surgery (42 per cent) and financial cost (29 per cent). Given a second chance, 19·8 per cent of patients would undergo BCT instead of mastectomy. Conclusion This study has identified the considerations that women in Singapore have when deciding on breast cancer surgery. Some perceptions need to be addressed for women to make a fully informed decision, especially as one‐fifth regret their initial choice.
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Affiliation(s)
- W Q Lee
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - V K M Tan
- Division of Surgical Oncology National Cancer Centre Singapore Singapore.,Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore
| | - H M C Choo
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - J Ong
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - R Krishnapriya
- Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - S Khong
- Division of Surgical Oncology National Cancer Centre Singapore Singapore
| | - M Tan
- Division of Surgical Oncology National Cancer Centre Singapore Singapore
| | - Y R Sim
- Division of Surgical Oncology National Cancer Centre Singapore Singapore
| | - B K Tan
- Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore.,Department of General Surgery Singapore General Hospital Singapore
| | - P Madhukumar
- Division of Surgical Oncology National Cancer Centre Singapore Singapore.,Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore
| | - W S Yong
- Division of Surgical Oncology National Cancer Centre Singapore Singapore.,Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore
| | - K W Ong
- Division of Surgical Oncology National Cancer Centre Singapore Singapore.,Singhealth Duke-NUS Breast Centre National Cancer Centre Singapore Singapore
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Miaja Ávila M, Moral de la Rubia J, Villarreal-Garza C. Fase cualitativa del desarrollo de una Escala de Motivos a favor y en contra de la Reconstrucción Mamaria (EMRM). PSICOONCOLOGIA 2018. [DOI: 10.5209/psic.61439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: Aunque en la clínica e investigación del cáncer de mama se considera las razones para hacerse la reconstrucción mamaria, no existe una escala validada para su evaluación. El objetivo del estudio fue crear una escala para medir los motivos a favor y en contra de la reconstrucción mamaria. Método: A través de la técnica de las redes semánticas naturales, se obtuvieron los ítems de la escala, y a través de un juicio de expertos estos fueron modificados. La técnica de las redes semánticas se aplicó a 65 mujeres mexicanas con cáncer de mama. El grupo de expertos quedó formado por 12 especialistas en cáncer de mama. Resultados: El núcleo central de los motivos para hacerse la reconstrucción mamaria se compuso de 16 motivos, los cuales se pueden agrupar en estéticos/imagen corporal, funcionales, emocionales/psicológicos y de relación con los hijos y la pareja. El núcleo central de los motivos en contra de hacerse la reconstrucción mamaria se compuso de 11 motivos, los cuales se pueden agrupar en miedos, aceptación/comodidad con la situación presente, costos y salud. Desde estos contenidos se redactaron 16 ítems sobre motivos para hacerse la reconstrucción y 11 en contra. Esta escala de 27 ítems fue evaluada en adecuación y comprensibilidad por el grupo de 12 expertos. Se conservaron los 27 ítems, pero siete ítems fueron modificados. Finalmente, se añadieron dos ítems sobre la falta de información señalada en estudios en México. Conclusiones: Se sugiere estudiar la confiabilidad, validez y distribución de la escala de 29 ítems.
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Pierrisnard C, Baciuchka M, Mancini J, Rathelot P, Vanelle P, Montana M. Body image and psychological distress in women with breast cancer: a French online survey on patients' perceptions and expectations. Breast Cancer 2017; 25:303-308. [PMID: 29288390 DOI: 10.1007/s12282-017-0828-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/25/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Altered body image caused by alopecia, loss of eyebrows or eyelashes, or mastectomy is a major source of psychological distress in women with breast cancer. OBJECTIVE To identify and to assess patients' perceptions and expectations regarding altered body image. METHOD Opinion survey conducted among patients treated for breast cancer and member of French online support groups. Anonymous online self-administered survey sent to women with breast cancer. RESULTS 85% of the women interviewed experienced alopecia during treatment and 67% of them loss of eyebrows or eyelashes. About half of patients suffering alopecia and loss of eyebrows or eyelashes reported fearing what others think. Mastectomy was experienced by 84% of the women in our study, but only 32% of them reported fearing what others think. 87% of our study cohort received information about the possibility of adverse events. 70, 56, and 60% of women felt helped by information they received for the management of alopecia, loss of eyebrows or eyelashes, or mastectomy, respectively. CONCLUSION This study confirms that altered body image is a critical psychosocial issue for women with breast cancer. Effective information can be a source of reassurance and may constitute one of the most important sources of emotional support.
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Affiliation(s)
- Camille Pierrisnard
- Aix Marseille University, APHM, Oncopharma Unit, Chemin des Bourrely, 13015, Marseille, France
| | - Marjorie Baciuchka
- Aix Marseille University, APHM, Oncologie Multidisciplinaire et Innovations Thérapeutiques, Chemin des Bourrely, 13015, Marseille, France
| | - Julien Mancini
- Aix-Marseille University, Inserm, IRD, UMR912, SESSTIM, "Cancers, Biomedicine & Society" Group, Institut Paoli-Calmettes, 232 Bd Ste Marguerite, 13273, Marseille, France.,APHM, BiosTIC, La Timone Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Pascal Rathelot
- Aix-Marseille University, APHM, Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP, Marseille, France.,Aix-Marseille University, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, 27 Bd Jean Moulin, 13385, Marseille Cedex 05, France
| | - Patrice Vanelle
- Aix-Marseille University, APHM, Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP, Marseille, France.,Aix-Marseille University, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, 27 Bd Jean Moulin, 13385, Marseille Cedex 05, France
| | - Marc Montana
- Aix Marseille University, APHM, Oncopharma Unit, Chemin des Bourrely, 13015, Marseille, France. .,Aix-Marseille University, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, 27 Bd Jean Moulin, 13385, Marseille Cedex 05, France.
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18
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Manne SL, Topham N, Kirstein L, Virtue SM, Brill K, Devine KA, Gajda T, Frederick S, Darabos K, Sorice K. Attitudes and Decisional Conflict Regarding Breast Reconstruction Among Breast Cancer Patients. Cancer Nurs 2017; 39:427-436. [PMID: 26780376 PMCID: PMC4947023 DOI: 10.1097/ncc.0000000000000320] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The decision to undergo breast reconstruction (BR) surgery after mastectomy is made during stressful circumstances. Many women do not feel well prepared to make this decision. OBJECTIVE Using the Ottawa Decision Support Framework, this study aims to describe women's reasons to choose or not choose BR, BR knowledge, decisional preparedness, and decisional conflict about BR. Possible demographic, medical, BR knowledge, and attitudinal correlates of decisional conflict about BR were also evaluated. METHODS Participants were 55 women with early-stage breast cancer drawn from the baseline data of a pilot randomized trial evaluating the efficacy of a BR decision support aid for breast cancer patients considering BR. RESULTS The most highly ranked reasons to choose BR were the desire for breasts to be equal in size, the desire to wake up from surgery with a breast in place, and perceived bother of a scar with no breast. The most highly ranked reasons not to choose BR were related to the surgical risks and complications. Regression analyses indicated that decisional conflict was associated with higher number of reasons not to choose BR and lower levels of decisional preparedness. CONCLUSIONS The results suggest that breast cancer patients considering BR may benefit from decisional support. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals may facilitate decision making by focusing on reasons for each patient's uncertainty and unaddressed concerns. All patients, even those who have consulted with a plastic surgeon and remain uncertain about their decision, may benefit from decision support from a health professional.
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Affiliation(s)
- Sharon L Manne
- Author Affiliations: Section of Population Science, Department of Medicine, Robert Wood Johnson Medical School, Rutgers, the Cancer Institute of New Jersey, New Brunswick (Drs Manne, Kirstein, Myers Virtue, and Devine and Mss Gajda, Frederick, and Darabos); Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Dr Topham); MD Anderson Cancer Center at Cooper Health Systems, Voorhees Township, New Jersey (Dr Brill); and Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Ms Sorice)
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Babin G, Commeny J, Fournier M, Rousvoal A, Kabbani Y, Debled M, Jaffre A, Tunon de Lara C. Reconstruction mammaire chez les patientes âgées : études des pratiques de l’institut Bergonié 2005–2015. Bull Cancer 2017; 104:508-515. [DOI: 10.1016/j.bulcan.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 02/09/2017] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
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20
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Making decisions about breast reconstruction: A systematic review of patient-reported factors influencing choice. Qual Life Res 2017; 26:2287-2319. [PMID: 28397191 DOI: 10.1007/s11136-017-1555-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Many studies have explored women's reasons for choosing or declining a particular type of breast reconstruction (BR) following mastectomy for breast cancer. This systematic review synthesises women's reasons for choosing a range of BR options, including no BR, in different settings and across time. METHODS Thirteen databases were systematically searched, with 30 studies (4269 participants), meeting the selection criteria. Information on study aim and time frame, participation rate, design/methods, limitations/bias, reasons and conclusions, as well as participant clinical and demographic information, was reported. An overall quality score was generated for each study. Reasons were grouped into eight domains. RESULTS While study methodology and results were heterogeneous, all reported reasons were covered by the eight domains: Feeling/looking normal; Feeling/looking good; Being practical; Influence of others; Relationship expectations; Fear; Timing; and Unnecessary. We found a strong consistency in reasons across studies, ranging from 52% of relevant publications citing relationship expectations as a reason for choosing BR, up to 91% citing fear as a reason for delaying or declining BR. Major thematic findings were a lack of adequate information about BR, lack of genuine choice for women and additional access limitations due to health system barriers. CONCLUSIONS Understanding women's reasons for wanting or not wanting BR can assist clinicians to help women make choices most aligned with their individual values and needs. Our thematic findings have equity implications and illustrate the need for surgeons to discuss all clinically appropriate BR options with mastectomy patients, even if some options are not available locally.
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21
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Kulkarni AR, Pusic AL, Hamill JB, Kim HM, Qi J, Wilkins EG, Roth RS. Factors Associated with Acute Postoperative Pain Following Breast Reconstruction. JPRAS Open 2016; 11:1-13. [PMID: 28713853 DOI: 10.1016/j.jpra.2016.08.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Post-mastectomy breast reconstruction has become an increasingly important component of breast cancer treatment. Unfortunately, some patients experience severe postoperative pain, placing them at risk for increased clinical morbidity and the development of disabling chronic pain. In an attempt to identify at-risk patients, we prospectively evaluated patient characteristics and medical/surgical variables associated with more severe acute post-reconstruction pain. METHODS Women (N = 2207; one-week 82.8% response rate) undergoing breast reconstruction were assessed for pain experience, anxiety, depression, and sociodemographic characteristics prior to surgery. Pain assessments were made preoperatively and postoperative at 1-week using validated survey instruments including the McGill Pain Questionnaire-Short Form (MPQ-SF), Numerical Pain Rating Scale (NPRS), and BREAST-Q Chest and Upper Body scale. Depressive symptoms and anxiety severity were assessed by the Patient Health Questionnaire and Generalized Anxiety Disorders Scale, respectively. Mixed-effects regression modeling was used to examine the relationships between patient characteristics and medical/surgical factors and 1-week postoperative pain. RESULTS Younger age, bilateral reconstruction, and severity of preoperative pain, anxiety and depression were all associated with more severe acute postoperative pain on all the pain measures and BREAST-Q. Comparison of surgical procedure type indicated less severe postoperative pain for PTRAM, DIEP and SIEA reconstructive surgery compared to tissue expander/implant reconstruction. CONCLUSIONS This study identified patients at risk for greater acute postoperative pain following breast reconstruction. These findings will allow plastic surgeons to better tailor postoperative care to improve patient comfort, reduce clinical morbidity, and further enhance patient satisfaction with their surgical outcome.
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Affiliation(s)
| | | | | | - Hyungjin M Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI
| | - Ji Qi
- University of Michigan Healthcare Systems, Ann Arbor, MI
| | | | - Randy S Roth
- University of Michigan Healthcare Systems, Ann Arbor, MI
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22
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Breast reconstruction and risk of lymphedema after mastectomy: A prospective cohort study with 10 years of follow-up. J Plast Reconstr Aesthet Surg 2016; 69:1218-26. [DOI: 10.1016/j.bjps.2016.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 05/25/2016] [Accepted: 06/04/2016] [Indexed: 11/23/2022]
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Dasgupta P, Youl PH, Pyke C, Aitken JF, Baade PD. Geographical disparity in breast reconstruction following mastectomy has reduced over time. ANZ J Surg 2016; 87:E183-E187. [DOI: 10.1111/ans.13710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/23/2016] [Accepted: 07/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Philippa H. Youl
- Cancer Council Queensland; Brisbane Queensland Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
- Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
| | | | - Joanne F. Aitken
- Cancer Council Queensland; Brisbane Queensland Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
- School of Population Health; The University of Queensland; Brisbane Queensland Australia
| | - Peter D. Baade
- Cancer Council Queensland; Brisbane Queensland Australia
- School of Public Health and Social Work; Queensland University of Technology; Brisbane Queensland Australia
- Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
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Lamore K, Quintard B, Flahault C, Van Wersch A, Untas A. [Evaluation of the impact of breast reconstruction in women in couple through a community-based research tool: The Seintinelles]. Bull Cancer 2016; 103:524-34. [PMID: 27206823 DOI: 10.1016/j.bulcan.2016.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/01/2016] [Accepted: 03/27/2016] [Indexed: 11/16/2022]
Abstract
This preliminary study explores the psychological and marital impact of breast reconstruction (or lack thereof) in women who had a mastectomy due to breast cancer. The study was carried out through an innovative and French community-based research tool on cancer: the Seintinelles. Sixty-nine partnered women treated for breast cancer participated, divided into 3 groups: 19 without breast reconstruction, 24 with immediate breast reconstruction and 26 with delayed breast reconstruction. They completed online questionnaires measuring both satisfaction and regret about the decision related to breast reconstruction, quality of life after breast surgery (EORTC-BRR), emotional state (POMS) and marital intimacy (PAIR). Recruitment through the Seintinelles had the advantage of being quick and national, but the profile of participants deviated from the mean population in the sense that our subjects were on average younger than women affected by breast cancer and had faced more breast cancer in their family. The results revealed that women are satisfied with their choice (little regret), have a similar emotional experience and good marital intimacy. However, women without breast reconstruction would less recommend their decision to others and were less satisfied with the aesthetic result, compared to women with breast reconstruction. These results highlight that psychological and marital impact seems comparable in women with and without reconstruction. Future studies are needed to better understand the role of the partner in the recourse of breast reconstruction.
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Affiliation(s)
- Kristopher Lamore
- Université Paris Descartes, Sorbonne Paris Cité, laboratoire de psychopathologie et processus de santé (LPPS), EA 4057, 71, avenue Edouard-Vaillant, 92774 Boulogne-Billancourt cedex, France.
| | - Bruno Quintard
- Université de Bordeaux, Inserm U1219, Bordeaux Population Health Research Center, équipe psycho-épidémiologie du vieillissement et des maladies chroniques, 3 ter, place de la Victoire, 33076 Bordeaux cedex, France
| | - Cécile Flahault
- Université Paris Descartes, Sorbonne Paris Cité, laboratoire de psychopathologie et processus de santé (LPPS), EA 4057, 71, avenue Edouard-Vaillant, 92774 Boulogne-Billancourt cedex, France
| | - Anna Van Wersch
- Université de Teesside, département de psychologie, Middlesbrough, TS1 3BA, Royaume-Uni
| | - Aurélie Untas
- Université Paris Descartes, Sorbonne Paris Cité, laboratoire de psychopathologie et processus de santé (LPPS), EA 4057, 71, avenue Edouard-Vaillant, 92774 Boulogne-Billancourt cedex, France
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